Prathima Mandava, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501014026 Issued in MI

Practice address

12947 Townsend Dr
# 812
Grand Ledge, MI 48837-8727

Phone

(906) 250-8223

NPI assigned

Sep 11, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legacy Healthcare Services Inc.

  • Physical Therapist
  • Cedar Park, TX
  • NPI 1871132357
  Medicare reassignment NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489
  NPD
• Adaptive Rehabilitation Clinics, LLC

  • Physical Therapist
  • Niles, OH
  • NPI 1568085579
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221091200000",
    "number": "1063661288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12947 TOWNSEND DR",
            "address_2": "# 812",
            "city": "GRAND LEDGE",
            "state": "MI",
            "postal_code": "488378727",
            "telephone_number": "906-250-8223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12947 TOWNSEND DR",
            "address_2": "# 812",
            "city": "GRAND LEDGE",
            "state": "MI",
            "postal_code": "488378727",
            "telephone_number": "906-250-8223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDAVA",
        "first_name": "PRATHIMA",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-11",
        "last_updated": "2008-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501014026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert John Leindecker, DC
• Lighthouse Massage and Yoga
• Robert Matthew Lipps, LMSW
• Lo Optical, LLC
• Deborah Lynn Mackersie, MD
• Michael Mangan, D.O.
• Tessa Rae Marks
• Michael Allen Marowelli
• Melissa Grace Marshall, D.C.
• Larry J Martin, PH.D.

• Physical Therapist in Grand Ledge, MI
• Providers in Grand Ledge, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.